Simultaneous open rhinoplasty and upper lip lift (bullhorn) as part of the facial feminization surgery

Introduction. The face is one of the most visible external gender markers, and misinterpretation of the appearance of transsexual people by others can not only affect the mental health of these patients, but also exacerbate the discrimination resulting from transphobia. As the central structure of the face, the nose is located in the middle third of the face and plays an important role in the perception of femininity. The lip area is the aesthetic focus of the lower third of the face. Correction of the area of the upper lip reduces the distance from the base of the nose to the vermilion zone that gives these patients femininity, harmonizes the anthropometric proportions of the face and forms a female type of smile. Thus, the upper lip lift (bullhorn) is a very important component of facial feminization. Taking into account the proximity of the above anatomical zones and the need to perform several tasks during facial feminization surgery, our team made a decision to perform simultaneous correction of the nose and upper lip area, which was the subject of our study. The purpose of this research was to study the effectiveness and safety of a combination of these surgical interventions.
Material and methods. We performed a complex of operations: simultaneous open rhinoplasty and lip lift (bullhorn) according to the original method to 10 Caucasian patients living in Eastern Europe at the age of 18 to 40 years with the diagnosis of transsexualism, nuclear type at the Department of Oncology, Radiation Therapy, and Reconstructive Surgery of the Institute of Clinical Medicine of the Sechenov First Moscow State Medical University (Moscow) during the period from January 2020 to December 2022. In combination of open rhinoplasty and bullhorn, we combine the same incision, while the skin is completely lifted above the columella so as to visualize the medial crura of the lower lateral cartilages.
Results. We observed the patients operated by us for 6-24 months after the surgery. No intraoperative surgical complications were noted during these operation complex. We conducted a survey using a 5-point Likert scale to assess the degree of satisfaction with the results of surgery, changes in their quality of life and psychosocial status after surgery. All patients were fully satisfied with the quality of the postoperative scar. All patients operated by us noted a significant improvement in their quality of life after surgery.
Conclusion. Thus, the method of simultaneous feminizing rhinoplasty and bullhorn performed by us has a number of advantages. With the combination of feminizing rhinoplasty and bullhorn surgery, it is possible to guarantee that the face will acquire a more feminine and harmonious look.
Key words: gender dysphoria, facial feminization (FFS), feminizing rhinoplasty, bullhorn, open rhinoplasty, facial anthropometry
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study